Genetic Problems Posed by Double Bind Theory

If schizophrenia be a modification or distortion of the learning process, then when we ask about the genetics of schizophrenia, we cannot be content just with genealogies upon which we discriminate some individuals who have been committed to hospitals, and others who have not. There is no a priori expectation that these distortions of the learning process, which are highly formal and abstract in their nature, will necessarily appear with that appropriate content which would result in hospital commitment. Our task as geneticists will not be the simple one upon which the Mendelians concentrated, assuming a one-to-one relation between phenotype and genotype. We cannot simply assume that the hospitalized members carry a gene for schizophrenia and that the others do not. Rather, we have to expect that several genes or constellations of genes will alter patterns and potentialities in the learning process, and that certain of the resultant patterns, when confronted by appropriate forms of environmental stress, will lead to overt schizophrenia.

In the most general terms, any learning, be it the absorption of one bit of information or a basic change in the character structure of the whole organism, is, from the point of view of genetics, the acquisition of an "acquired characteristic." It is a change in the phenotype, of which that phenotype was capable thanks to a whole chain of physiologic and embryologic processes which lead back to the genotype. Every step in this backward leading series may (conceivably) be modified or interrupted by environmental impacts; but, of course, many of the steps will be rigid in the sense that environmental impact at that point would destroy the organism. We are concerned only with those points in the hierarchy at which environment can take effect and the organism still be viable. How many such points there may be we are far from knowing. And ultimately, when we reach the genotype, we are concerned to know whether the genotypic elements in which we are interested are or are not variable. Do differences occur from genotype to genotype which will affect the modifiability of the processes leading to the phenotypic behaviors which we observe?

In the case of schizophrenia we deal evidently with a relatively long and complex hierarchy; and the natural history of the disease indicates that the hierarchy is not merely a chain of causes and effects from gene-script to phenotype, which chain would suggest that atrophy of an organ, occurring at the somatic level, may constitute a drain upon the total available adaptability of the organism, and that this waste of adaptability might be saved if reduction of the organ could be achieved more directly by genetic determinants.

becomes at certain points conditional upon environmental factors. Rather, it seems that in schizophrenia the enviromental factors themselves are likely to be modified by the subject's behavior whenever behavior related to schizophrenia starts to appear.

To illustrate these complexities, it is perhaps worthwhile to consider for a moment the genetic problems presented by other forms of communicational behavior—humor, mathematical skill, or musical composition. Perhaps in all these cases, there are considerable genetic differences between individuals in those factors which make for an ability to acquire the appropriate skills. But the skills themselves and their particular expression also depend largely upon environmental circumstances and even upon specific training. In addition, however, to these two components of the situation, there is the fact that the individual who shows ability, e.g., in musical composition, is likely to mold his environment in a direction which will favor his developing his ability, and that he will, in turn, create an environment for others which will favor their development in the same direction.

In the case of humor, the situation may even be one degree more complicated. It is not clear that in this case the relationship between humorist and his human environment will necessarily be symmetrical. Granted that in some cases the humorist promotes humor in others, in many other cases there occurs the well-known complementary relationship between humorist and "straight" man. Indeed, the humorist, insofar as he hogs the center of the stage, may reduce others to the position of receiving humor but not themselves contributing.

These considerations can be applied unchanged to the problem of schizophrenia. Anybody watching the trans-actions which occur between the members of a family containing an identified schizophrenic will perceive immediately that the symptomatic behavior of the identified patient fits with this environment and, indeed, promotes in the other members those characteristics which.evoke the schizophrenic behavior. Thus, in addition to the two stochastic mechanisms outlined in the previous section, we now face a third, namely the mechanism of those changes whereby the family, perhaps gradually, becomes organized (i.e., limits the behaviors of the component individuals) in such a way as to fit the schizophrenia.

A question which is frequently asked is this: "If this family is schizophrenogenic, how does it happen that all of the siblings are not diagnosable as schizophrenic patients?" Here it is necessary to insist that the family, like any other organization, creates and depends upon differentiation among its members. As in many organizations, there is room only for one boss, in spite of the fact that the organization operates upon those premises which would induce administrative skill and ambition in its members; so also in the schizophrenogenic family there may be room for only one schizophrenic. The case of the humorist is quite comparable. The organization of the Marx family, which could create four professional humorists, must have been quite exceptional. More usually one such individual would suffice to re-duce the others to more commonplace behavioral roles. Gene-tics may play a role in deciding which of several siblings shall be the schizophrenic—or which shall be the clown—but it is by no means clear that such hereditary factors could completely determine the evolution or roles within the family organization.

A second question—to which we have no final answer—concerns the degree of schizophrenia (genetic and/ or acquired) which must be assigned to the schizophrenogenic parent. Let me, for purposes of the present inquiry, define two degrees of schizophrenic symptomatology, and note that the so-called "psychotic break" sometimes divides these two degrees.

The more serious and conspicuous degree of symptomatology is what is conventionally called schizophrenia. I will call it "overt schizophrenia." The persons so afflicted be-have in ways which are grossly deviant from the cultural-environment. In particular, their behavior seems characterized by conspicuous or exaggerated errors and distortions regarding the nature and typing of their own messages (internal and external), and of the messages which they receive from others. Imagination is seemingly confused with perception. The literal is confused with the metaphoric. Internal messages are confused with external. The trivial is confused with the vital. The originator of the message is confused with the recipient and the perceiver with the thing perceived. And so on. In general, these distortions boil down to this: that the patient behaves in such a way that he shall be responsible for no metacommunicative aspect of his messages. He does this, moreover, in a manner which makes his condition conspicuous: in some cases, flooding the environment with messages whose logical typing is either totally obscure or misleading; in other cases, overtly withdrawing to such a point that he commits himself to no overt message.

In the "covert" case the behavior of the identified patient is similarly but less conspicuously characterized by a continual changing of the logical typing of his or her messages, and a tendency to respond to the messages of others (especially to those of other family members) as though these were of logical type, different from that which the speaker intended. In this system of behavior the messages of the vis-avis are continually disqualified, either by indicating that they are inappropriate replies to what the covert schizophrenic has said or by indicating that they are the product of some fault in the character or motivation of the speaker. Moreover, this destructive behavior is in general maintained in such a way as to be undetected. So long as the covert schizophrenic can succeed in putting the other in the wrong, his or her pathology is obscured and the blame falls else-where. There is some evidence that these persons fear col-lapse into overt schizophrenia when faced by circumstances which would force them to recognize the pattern of their operations. They will even use the threat, "You are driving me crazy," as a defense of their position.

What I am here calling covert schizophrenia is characteristic of the parents of schizophrenics in the families which we have studied. This behavior, when it occurs in the mother, has been extensively caricatured; so I shall use here an example of which the central figure is the father. Mr. and Mrs. P. had been married some eighteen years and have a near-hebephrenic son of sixteen. Their marriage is difficult and is characterized by almost continual hostility. However, she is a keen gardener, and on a certain Sunday afternoon they worked together planting roses in what was to be her rose garden. She recalls that this was an unusually pleasant occasion. On Monday morning, the husband went to work as usual, and while he was gone Mrs. P. received a phone call from a complete stranger inquiring, rather apologetically, when Mrs. P. was going to leave the house. This came as somewhat of a surprise. She did not know that from her husband's point of view the messages of shared work on the rose garden were framed within the larger context of his having agreed during the previous week to sell the house.

In some cases, it almost looks as though the overt schizophrenic were a caricature of the covert.

If we assume that both the grossly schizophrenic symptoms of the identified patient and the "covert schizophrenia" of the parents are in part determined by genetic factors, i.e., that, given the appropriate experiential setting, genetics in some degree renders the patient more liable to develop these particular patterns of behavior, then we have to ask how these two degrees of pathology might be related in a genetic theory.

Certainly, no answer to this question is at present avail-able, but it is clearly possible we here face two quite distinct problems. In the case of the overt schizophrenic, the geneticist will have to identify those formal characteristics of the patient which will render him more likely to be driven to a psychotic break by the covertly inconsistent behavior of his parents (or by this in conjunction and contrast with the more consistent behavior of people outside the family). It is too early to make a specific guess at these characteristics, but we may reasonably assume that they would include some sort of rigidity. Perhaps the person prone to overt schizophrenia would be characterized by some extra strength of psychological commitment to the status quo as he at the moment sees it, which commitment would be hurt or frustrated by the parents' rapid shifts of frame and context. Or perhaps this patient might be characterized by the high value of some parameter determining the relationship between problem solving and habit formation. Perhaps it is the person who too readily hands over the solutions to habit who is hurt by those changes in context which invalidate his solutions just at the moment when he has incorporated them into his habit structure.

In the case of covert schizophrenia, the problem for the geneticist will be different. He will have to identify those formal characteristics which we observe in the parents of the schizophrenic. Here what is required would seem to be a flexibility rather than a rigidity. But, having had some experience in dealing with these people, 'I must confess to feeling that they are rigidly committed to their patterns of inconsistency.

Whether the two questions which the geneticist must answer can simply be lumped together by regarding the covert patterns as merely a milder version of the overt, or can be brought under a single head by suggesting that in some sense the same rigidity operates at different levels in the two cases, I do not know.

Be that as it may, the difficulties which we here face are entirely characteristic of any attempt to find a genetic base for any behavioral characteristic. Notoriously, the sign of any message or behavior is subject to reversal, and this generalization is one of the most important. contributions of psycho-analysis, to our thinking. If we find that a sexual exhibitionist is the child of a prudish parent, are we justified in going to the geneticist to ask him to trace out the genetics of some basic characteristic which will find its phenotypic expression both in the prudishness of the parent and in the exhibitionism of the offspring? The phenomena of suppression and overcompensation lead continually to the difficulty that an excess of something at one level (e.g., in the genotype) may lead to a deficiency of the direct expression of that something at , some more superficial level (e.g,. in the phenotype). And conversely.

We are very far, then, from being able to pose specific questions for the geneticist; but I believe that the wider implications of what I have been saying modify somewhat the philosophy of genetics. Our approach to the problems of schizophrenia by way of a theory of levels or logical types has disclosed first that the problems of adaptation and learning and their pathologies must be considered in terms of a hierarchic system in which stochastic change occurs at the boundary points between the segments of the hierarchy. We have considered three such regions of stochastic change —the level of genetic mutation, the level of learning, and the level of change in family organization. We have disclosed the possibility of a relationship of these levels which orthodox genetics would deny, and we have disclosed that at least in human societies the evolutionary system consists not merely in the selective survival of those persons who happen to select appropriate environments but also in the modification of family environment in a direction which might enhance the phenotypic and genotypic characteristics of the individual members.

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